|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
IP
|
$31,594.10
|
|
|
Service Code
|
MS-DRG 473
|
| Min. Negotiated Rate |
$21,387.69 |
| Max. Negotiated Rate |
$31,594.10 |
| Rate for Payer: Aetna Medicare |
$22,513.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,141.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,141.70
|
| Rate for Payer: BCBS MAPPO |
$22,513.36
|
| Rate for Payer: BCN Medicare Advantage |
$22,513.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,513.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,513.36
|
| Rate for Payer: Mclaren Medicare |
$22,513.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,639.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,890.36
|
| Rate for Payer: PACE Medicare |
$21,387.69
|
| Rate for Payer: PACE SWMI |
$22,513.36
|
| Rate for Payer: PHP Commercial |
$24,764.70
|
| Rate for Payer: PHP Medicare Advantage |
$22,513.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,594.10
|
| Rate for Payer: Priority Health Medicare |
$22,513.36
|
| Rate for Payer: Priority Health Narrow Network |
$25,275.28
|
| Rate for Payer: Railroad Medicare Medicare |
$22,513.36
|
| Rate for Payer: UHC Medicare Advantage |
$23,188.76
|
| Rate for Payer: VA VA |
$22,513.36
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
IP
|
$13,496.12
|
|
|
Service Code
|
MS-DRG 787
|
| Min. Negotiated Rate |
$10,050.96 |
| Max. Negotiated Rate |
$13,496.12 |
| Rate for Payer: Aetna Medicare |
$10,579.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,224.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,224.95
|
| Rate for Payer: BCBS MAPPO |
$10,579.96
|
| Rate for Payer: BCN Medicare Advantage |
$10,579.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,579.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,579.96
|
| Rate for Payer: Mclaren Medicare |
$10,579.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,108.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,166.95
|
| Rate for Payer: PACE Medicare |
$10,050.96
|
| Rate for Payer: PACE SWMI |
$10,579.96
|
| Rate for Payer: PHP Commercial |
$11,637.96
|
| Rate for Payer: PHP Medicare Advantage |
$10,579.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,496.12
|
| Rate for Payer: Priority Health Medicare |
$10,579.96
|
| Rate for Payer: Priority Health Narrow Network |
$10,796.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10,579.96
|
| Rate for Payer: UHC Medicare Advantage |
$10,897.36
|
| Rate for Payer: VA VA |
$10,579.96
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
IP
|
$22,463.58
|
|
|
Service Code
|
MS-DRG 786
|
| Min. Negotiated Rate |
$15,668.26 |
| Max. Negotiated Rate |
$22,463.58 |
| Rate for Payer: Aetna Medicare |
$16,492.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,616.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,616.12
|
| Rate for Payer: BCBS MAPPO |
$16,492.90
|
| Rate for Payer: BCN Medicare Advantage |
$16,492.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,492.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,492.90
|
| Rate for Payer: Mclaren Medicare |
$16,492.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,317.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,966.84
|
| Rate for Payer: PACE Medicare |
$15,668.26
|
| Rate for Payer: PACE SWMI |
$16,492.90
|
| Rate for Payer: PHP Commercial |
$18,142.19
|
| Rate for Payer: PHP Medicare Advantage |
$16,492.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,463.58
|
| Rate for Payer: Priority Health Medicare |
$16,492.90
|
| Rate for Payer: Priority Health Narrow Network |
$17,970.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16,492.90
|
| Rate for Payer: UHC Medicare Advantage |
$16,987.69
|
| Rate for Payer: VA VA |
$16,492.90
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
IP
|
$11,149.62
|
|
|
Service Code
|
MS-DRG 788
|
| Min. Negotiated Rate |
$8,473.72 |
| Max. Negotiated Rate |
$11,149.62 |
| Rate for Payer: Aetna Medicare |
$8,919.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,149.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,149.62
|
| Rate for Payer: BCBS MAPPO |
$8,919.70
|
| Rate for Payer: BCN Medicare Advantage |
$8,919.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,919.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,919.70
|
| Rate for Payer: Mclaren Medicare |
$8,919.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,365.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,257.66
|
| Rate for Payer: PACE Medicare |
$8,473.72
|
| Rate for Payer: PACE SWMI |
$8,919.70
|
| Rate for Payer: PHP Commercial |
$9,811.67
|
| Rate for Payer: PHP Medicare Advantage |
$8,919.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,978.20
|
| Rate for Payer: Priority Health Medicare |
$8,919.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,782.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,919.70
|
| Rate for Payer: UHC Medicare Advantage |
$9,187.29
|
| Rate for Payer: VA VA |
$8,919.70
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
IP
|
$13,149.44
|
|
|
Service Code
|
MS-DRG 784
|
| Min. Negotiated Rate |
$9,833.81 |
| Max. Negotiated Rate |
$13,149.44 |
| Rate for Payer: Aetna Medicare |
$10,351.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,939.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,939.22
|
| Rate for Payer: BCBS MAPPO |
$10,351.38
|
| Rate for Payer: BCN Medicare Advantage |
$10,351.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,351.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,351.38
|
| Rate for Payer: Mclaren Medicare |
$10,351.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,868.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,904.09
|
| Rate for Payer: PACE Medicare |
$9,833.81
|
| Rate for Payer: PACE SWMI |
$10,351.38
|
| Rate for Payer: PHP Commercial |
$11,386.52
|
| Rate for Payer: PHP Medicare Advantage |
$10,351.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,149.44
|
| Rate for Payer: Priority Health Medicare |
$10,351.38
|
| Rate for Payer: Priority Health Narrow Network |
$10,519.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10,351.38
|
| Rate for Payer: UHC Medicare Advantage |
$10,661.92
|
| Rate for Payer: VA VA |
$10,351.38
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
IP
|
$22,749.91
|
|
|
Service Code
|
MS-DRG 783
|
| Min. Negotiated Rate |
$15,847.62 |
| Max. Negotiated Rate |
$22,749.91 |
| Rate for Payer: Aetna Medicare |
$16,681.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,852.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,852.12
|
| Rate for Payer: BCBS MAPPO |
$16,681.70
|
| Rate for Payer: BCN Medicare Advantage |
$16,681.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,681.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,681.70
|
| Rate for Payer: Mclaren Medicare |
$16,681.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,515.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,183.96
|
| Rate for Payer: PACE Medicare |
$15,847.62
|
| Rate for Payer: PACE SWMI |
$16,681.70
|
| Rate for Payer: PHP Commercial |
$18,349.87
|
| Rate for Payer: PHP Medicare Advantage |
$16,681.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,749.91
|
| Rate for Payer: Priority Health Medicare |
$16,681.70
|
| Rate for Payer: Priority Health Narrow Network |
$18,199.93
|
| Rate for Payer: Railroad Medicare Medicare |
$16,681.70
|
| Rate for Payer: UHC Medicare Advantage |
$17,182.15
|
| Rate for Payer: VA VA |
$16,681.70
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
IP
|
$11,269.22
|
|
|
Service Code
|
MS-DRG 785
|
| Min. Negotiated Rate |
$8,564.61 |
| Max. Negotiated Rate |
$11,269.22 |
| Rate for Payer: Aetna Medicare |
$9,015.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,269.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,269.22
|
| Rate for Payer: BCBS MAPPO |
$9,015.38
|
| Rate for Payer: BCN Medicare Advantage |
$9,015.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,015.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,015.38
|
| Rate for Payer: Mclaren Medicare |
$9,015.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,466.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,367.69
|
| Rate for Payer: PACE Medicare |
$8,564.61
|
| Rate for Payer: PACE SWMI |
$9,015.38
|
| Rate for Payer: PHP Commercial |
$9,916.92
|
| Rate for Payer: PHP Medicare Advantage |
$9,015.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,123.29
|
| Rate for Payer: Priority Health Medicare |
$9,015.38
|
| Rate for Payer: Priority Health Narrow Network |
$8,898.63
|
| Rate for Payer: Railroad Medicare Medicare |
$9,015.38
|
| Rate for Payer: UHC Medicare Advantage |
$9,285.84
|
| Rate for Payer: VA VA |
$9,015.38
|
|
|
CHEMICAL PEELS
|
Professional
|
$75.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
IP
|
$61,074.74
|
|
|
Service Code
|
MS-DRG 837
|
| Min. Negotiated Rate |
$40,557.55 |
| Max. Negotiated Rate |
$61,074.74 |
| Rate for Payer: Aetna Medicare |
$42,692.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,365.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,365.20
|
| Rate for Payer: BCBS MAPPO |
$42,692.16
|
| Rate for Payer: BCN Medicare Advantage |
$42,692.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,692.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,692.16
|
| Rate for Payer: Mclaren Medicare |
$42,692.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,826.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,095.98
|
| Rate for Payer: PACE Medicare |
$40,557.55
|
| Rate for Payer: PACE SWMI |
$42,692.16
|
| Rate for Payer: PHP Commercial |
$46,961.38
|
| Rate for Payer: PHP Medicare Advantage |
$42,692.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,074.74
|
| Rate for Payer: Priority Health Medicare |
$42,692.16
|
| Rate for Payer: Priority Health Narrow Network |
$48,859.79
|
| Rate for Payer: Railroad Medicare Medicare |
$42,692.16
|
| Rate for Payer: UHC Medicare Advantage |
$43,972.92
|
| Rate for Payer: VA VA |
$42,692.16
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
IP
|
$25,068.82
|
|
|
Service Code
|
MS-DRG 838
|
| Min. Negotiated Rate |
$17,696.72 |
| Max. Negotiated Rate |
$25,068.82 |
| Rate for Payer: Aetna Medicare |
$18,628.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,285.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,285.16
|
| Rate for Payer: BCBS MAPPO |
$18,628.13
|
| Rate for Payer: BCN Medicare Advantage |
$18,628.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,628.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,628.13
|
| Rate for Payer: Mclaren Medicare |
$18,628.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,559.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,422.35
|
| Rate for Payer: PACE Medicare |
$17,696.72
|
| Rate for Payer: PACE SWMI |
$18,628.13
|
| Rate for Payer: PHP Commercial |
$20,490.94
|
| Rate for Payer: PHP Medicare Advantage |
$18,628.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,068.82
|
| Rate for Payer: Priority Health Medicare |
$18,628.13
|
| Rate for Payer: Priority Health Narrow Network |
$20,055.06
|
| Rate for Payer: Railroad Medicare Medicare |
$18,628.13
|
| Rate for Payer: UHC Medicare Advantage |
$19,186.97
|
| Rate for Payer: VA VA |
$18,628.13
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$16,731.80
|
|
|
Service Code
|
MS-DRG 839
|
| Min. Negotiated Rate |
$12,077.82 |
| Max. Negotiated Rate |
$16,731.80 |
| Rate for Payer: Aetna Medicare |
$12,713.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,891.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,891.88
|
| Rate for Payer: BCBS MAPPO |
$12,713.50
|
| Rate for Payer: BCN Medicare Advantage |
$12,713.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,713.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,713.50
|
| Rate for Payer: Mclaren Medicare |
$12,713.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,349.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,620.52
|
| Rate for Payer: PACE Medicare |
$12,077.82
|
| Rate for Payer: PACE SWMI |
$12,713.50
|
| Rate for Payer: PHP Commercial |
$13,984.85
|
| Rate for Payer: PHP Medicare Advantage |
$12,713.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,731.80
|
| Rate for Payer: Priority Health Medicare |
$12,713.50
|
| Rate for Payer: Priority Health Narrow Network |
$13,385.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12,713.50
|
| Rate for Payer: UHC Medicare Advantage |
$13,094.90
|
| Rate for Payer: VA VA |
$12,713.50
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
IP
|
$15,569.78
|
|
|
Service Code
|
MS-DRG 847
|
| Min. Negotiated Rate |
$11,349.94 |
| Max. Negotiated Rate |
$15,569.78 |
| Rate for Payer: Aetna Medicare |
$11,947.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,934.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,934.12
|
| Rate for Payer: BCBS MAPPO |
$11,947.30
|
| Rate for Payer: BCN Medicare Advantage |
$11,947.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,947.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,947.30
|
| Rate for Payer: Mclaren Medicare |
$11,947.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,544.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,739.40
|
| Rate for Payer: PACE Medicare |
$11,349.94
|
| Rate for Payer: PACE SWMI |
$11,947.30
|
| Rate for Payer: PHP Commercial |
$13,142.03
|
| Rate for Payer: PHP Medicare Advantage |
$11,947.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,569.78
|
| Rate for Payer: Priority Health Medicare |
$11,947.30
|
| Rate for Payer: Priority Health Narrow Network |
$12,455.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11,947.30
|
| Rate for Payer: UHC Medicare Advantage |
$12,305.72
|
| Rate for Payer: VA VA |
$11,947.30
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
IP
|
$31,380.96
|
|
|
Service Code
|
MS-DRG 846
|
| Min. Negotiated Rate |
$21,254.17 |
| Max. Negotiated Rate |
$31,380.96 |
| Rate for Payer: Aetna Medicare |
$22,372.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,966.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,966.01
|
| Rate for Payer: BCBS MAPPO |
$22,372.81
|
| Rate for Payer: BCN Medicare Advantage |
$22,372.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,372.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,372.81
|
| Rate for Payer: Mclaren Medicare |
$22,372.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,491.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,728.73
|
| Rate for Payer: PACE Medicare |
$21,254.17
|
| Rate for Payer: PACE SWMI |
$22,372.81
|
| Rate for Payer: PHP Commercial |
$24,610.09
|
| Rate for Payer: PHP Medicare Advantage |
$22,372.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,380.96
|
| Rate for Payer: Priority Health Medicare |
$22,372.81
|
| Rate for Payer: Priority Health Narrow Network |
$25,104.77
|
| Rate for Payer: Railroad Medicare Medicare |
$22,372.81
|
| Rate for Payer: UHC Medicare Advantage |
$23,043.99
|
| Rate for Payer: VA VA |
$22,372.81
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$10,950.68
|
|
|
Service Code
|
MS-DRG 848
|
| Min. Negotiated Rate |
$7,801.58 |
| Max. Negotiated Rate |
$10,950.68 |
| Rate for Payer: Aetna Medicare |
$8,760.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,950.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,950.68
|
| Rate for Payer: BCBS MAPPO |
$8,760.54
|
| Rate for Payer: BCN Medicare Advantage |
$8,760.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,760.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,760.54
|
| Rate for Payer: Mclaren Medicare |
$8,760.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,198.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,074.62
|
| Rate for Payer: PACE Medicare |
$8,322.51
|
| Rate for Payer: PACE SWMI |
$8,760.54
|
| Rate for Payer: PHP Commercial |
$9,636.59
|
| Rate for Payer: PHP Medicare Advantage |
$8,760.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,751.98
|
| Rate for Payer: Priority Health Medicare |
$8,760.54
|
| Rate for Payer: Priority Health Narrow Network |
$7,801.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8,760.54
|
| Rate for Payer: UHC Medicare Advantage |
$9,023.36
|
| Rate for Payer: VA VA |
$8,760.54
|
|
|
CHEST PAIN
|
Facility
IP
|
$9,759.01
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$7,416.85 |
| Max. Negotiated Rate |
$9,759.01 |
| Rate for Payer: Aetna Medicare |
$7,807.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,759.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,759.01
|
| Rate for Payer: BCBS MAPPO |
$7,807.21
|
| Rate for Payer: BCN Medicare Advantage |
$7,807.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,807.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,807.21
|
| Rate for Payer: Mclaren Medicare |
$7,807.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,197.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,978.29
|
| Rate for Payer: PACE Medicare |
$7,416.85
|
| Rate for Payer: PACE SWMI |
$7,807.21
|
| Rate for Payer: PHP Commercial |
$8,587.93
|
| Rate for Payer: PHP Medicare Advantage |
$7,807.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,291.02
|
| Rate for Payer: Priority Health Medicare |
$7,807.21
|
| Rate for Payer: Priority Health Narrow Network |
$7,432.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7,807.21
|
| Rate for Payer: UHC Medicare Advantage |
$8,041.43
|
| Rate for Payer: VA VA |
$7,807.21
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
$1,346.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$455.49 |
| Max. Negotiated Rate |
$1,199.80 |
| Rate for Payer: PHP Medicare Advantage |
$455.49
|
| Rate for Payer: Aetna Commercial |
$610.36
|
| Rate for Payer: Aetna Commercial |
$610.36
|
| Rate for Payer: Aetna Medicare |
$455.49
|
| Rate for Payer: Aetna Medicare |
$455.49
|
| Rate for Payer: BCBS Complete |
$685.60
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$455.49
|
| Rate for Payer: BCBS MAPPO |
$455.49
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Medicare Advantage |
$455.49
|
| Rate for Payer: BCN Medicare Advantage |
$455.49
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cofinity Commercial |
$610.36
|
| Rate for Payer: Cofinity Commercial |
$655.91
|
| Rate for Payer: Cofinity Commercial |
$655.91
|
| Rate for Payer: Cofinity Commercial |
$610.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.49
|
| Rate for Payer: Healthscope Commercial |
$546.59
|
| Rate for Payer: Healthscope Commercial |
$546.59
|
| Rate for Payer: Healthscope Whirlpool |
$546.59
|
| Rate for Payer: Healthscope Whirlpool |
$546.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$478.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$478.26
|
| Rate for Payer: PACE SWMI |
$455.49
|
| Rate for Payer: PACE SWMI |
$455.49
|
| Rate for Payer: PHP Medicare Advantage |
$455.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,199.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.89
|
| Rate for Payer: Priority Health Medicare |
$455.49
|
| Rate for Payer: Priority Health Medicare |
$455.49
|
| Rate for Payer: Priority Health Narrow Network |
$731.89
|
| Rate for Payer: Priority Health Narrow Network |
$731.89
|
| Rate for Payer: UHC Medicare Advantage |
$469.15
|
| Rate for Payer: UHC Medicare Advantage |
$469.15
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
$134.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$116.26 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$72.74
|
| Rate for Payer: BCN Commercial |
$110.93
|
| Rate for Payer: BCN Medicare Advantage |
$72.74
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$97.47
|
| Rate for Payer: Cofinity Commercial |
$104.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.74
|
| Rate for Payer: Healthscope Commercial |
$87.29
|
| Rate for Payer: Healthscope Whirlpool |
$87.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.38
|
| Rate for Payer: PACE SWMI |
$72.74
|
| Rate for Payer: PHP Medicare Advantage |
$72.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.26
|
| Rate for Payer: Priority Health Medicare |
$72.74
|
| Rate for Payer: Priority Health Narrow Network |
$116.26
|
| Rate for Payer: UHC Medicare Advantage |
$74.92
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
$20.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Whirlpool |
$27.53
|
| Rate for Payer: Healthscope Whirlpool |
$27.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$36.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
$673.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$497.82 |
| Rate for Payer: Aetna Commercial |
$406.69
|
| Rate for Payer: Aetna Medicare |
$303.50
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCN Commercial |
$475.00
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$437.04
|
| Rate for Payer: Cofinity Commercial |
$406.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$364.20
|
| Rate for Payer: Healthscope Whirlpool |
$364.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.82
|
| Rate for Payer: Priority Health Medicare |
$303.50
|
| Rate for Payer: Priority Health Narrow Network |
$497.82
|
| Rate for Payer: UHC Medicare Advantage |
$312.60
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
$262.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: BCBS Complete |
$104.80
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
$302.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$347.90 |
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$194.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$248.91 |
| Rate for Payer: Aetna Commercial |
$210.66
|
| Rate for Payer: Aetna Medicare |
$157.21
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$157.21
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: BCN Medicare Advantage |
$157.21
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$226.38
|
| Rate for Payer: Cofinity Commercial |
$210.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.21
|
| Rate for Payer: Healthscope Commercial |
$188.65
|
| Rate for Payer: Healthscope Whirlpool |
$188.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.07
|
| Rate for Payer: PACE SWMI |
$157.21
|
| Rate for Payer: PHP Medicare Advantage |
$157.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.91
|
| Rate for Payer: Priority Health Medicare |
$157.21
|
| Rate for Payer: Priority Health Narrow Network |
$248.91
|
| Rate for Payer: UHC Medicare Advantage |
$161.93
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$178.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: Aetna Commercial |
$195.02
|
| Rate for Payer: Aetna Commercial |
$195.02
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: BCBS Complete |
$168.80
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: BCBS MAPPO |
$145.54
|
| Rate for Payer: BCBS MAPPO |
$145.54
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$145.54
|
| Rate for Payer: BCN Medicare Advantage |
$145.54
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$195.02
|
| Rate for Payer: Cofinity Commercial |
$195.02
|
| Rate for Payer: Cofinity Commercial |
$209.58
|
| Rate for Payer: Cofinity Commercial |
$209.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.54
|
| Rate for Payer: Healthscope Commercial |
$174.65
|
| Rate for Payer: Healthscope Commercial |
$174.65
|
| Rate for Payer: Healthscope Whirlpool |
$174.65
|
| Rate for Payer: Healthscope Whirlpool |
$174.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.82
|
| Rate for Payer: PACE SWMI |
$145.54
|
| Rate for Payer: PACE SWMI |
$145.54
|
| Rate for Payer: PHP Medicare Advantage |
$145.54
|
| Rate for Payer: PHP Medicare Advantage |
$145.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.47
|
| Rate for Payer: Priority Health Medicare |
$145.54
|
| Rate for Payer: Priority Health Medicare |
$145.54
|
| Rate for Payer: Priority Health Narrow Network |
$230.47
|
| Rate for Payer: Priority Health Narrow Network |
$230.47
|
| Rate for Payer: UHC Medicare Advantage |
$149.91
|
| Rate for Payer: UHC Medicare Advantage |
$149.91
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
$186.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$247.88 |
| Rate for Payer: Aetna Commercial |
$206.02
|
| Rate for Payer: Aetna Medicare |
$153.75
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: BCBS MAPPO |
$153.75
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$153.75
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$221.40
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.75
|
| Rate for Payer: Healthscope Commercial |
$184.50
|
| Rate for Payer: Healthscope Whirlpool |
$184.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.44
|
| Rate for Payer: PACE SWMI |
$153.75
|
| Rate for Payer: PHP Medicare Advantage |
$153.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.88
|
| Rate for Payer: Priority Health Medicare |
$153.75
|
| Rate for Payer: Priority Health Narrow Network |
$247.88
|
| Rate for Payer: UHC Medicare Advantage |
$158.36
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
$313.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$219.21 |
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Medicare |
$136.35
|
| Rate for Payer: BCBS Complete |
$125.20
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Healthscope Commercial |
$163.62
|
| Rate for Payer: Healthscope Whirlpool |
$163.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.21
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: Priority Health Narrow Network |
$219.21
|
| Rate for Payer: UHC Medicare Advantage |
$140.44
|
|
